PANS/PANDAS in the School Setting - Symptoms & Supports
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There are no set guidelines for supports and accommodations for students with PANS/PANDAS within the school setting. PANS/PANDAS is not a "one size fits all" medical condition therefore individualized support is required. Most students with PANS/PANDAS are eligible for accommodations and supports under a 504 plan if the medical condition substantially hinders the student’s ability to participate and manage the education curriculum. Individualized Education Plans (IEPs), under the Individuals with Disabilities Act (IDEA), are required for some students with PANS if special education and/or special services are warranted. Every child with PANS/PANDAS has different severity of symptoms and dissimilar symptoms from one student to the next. For most, school is difficult and requires appropriate accommodations and supports. Some children are too sick to attend school and will require home bound instruction.
More NEPANS Resources School Resources Signs of PANS @School School Nurses & Health Care Plans Excused Absences & Home Bound Laws PANS/PANDAS Fact Sheets |
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“therapy can be instrumental in negotiating exacerbation, but doing so requires a paradigm shift. Children often lose skills during exacerbation, and traditional remedial intervention may be ineffective. Greater benefit may be found with adaptation and compensation for problems during exacerbation, followed by remediation of ongoing problems during remission.” PANDAS: A New Frontier for Occupational Therapy Intervention - Janice Tona & Trudy Posner |
PANS/PANDAS - Symptoms @ School & Accommodations
Manifestation of PANS Symptoms in the School Setting
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BEHAVIORAL Symptoms
•Obsessive Compulsive Disorder •Obsessive Thinking (Inappropriate Thoughts/Rigid Thinking/Perfectionism) •Eating Issues (Limited Menu/Fear of Choking/Anorexia) •Anxiety (Separation Anxiety/School Refusal) •Aggression (Defiance/Rages) •Age Regression/Immaturity (Tantrums/Baby Talk) •ADHD (Fidgeting/Outbursts/Poor Impulse Control) •Sensory Issues |
ACADEMIC Symptoms
•Loss of Math Skills •Decline in Handwriting Skills (Dysgraphia) •Unable to Make Simple Decisions •Poor Short-Term Memory •Decline in Creative Work (Art, Creative Writing) •Avoidance of High Sensory Environments (Art, Music, Cafeteria, Physical Ed, etc…) •Loss of Focus on a Single Task •Work Refusal (School Work, Homework etc) •Perfectionism (Erasing thru paper, starting over) |
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PHYSICAL Symptoms
•Tics (Motor/Vocal) •Eye Issues (Dilated Pupils, Vision Issues, Hallucinations) •Eating Issues (Limited Menu/Fear of Choking/Anorexia) •Frequent Urination (Trips to the Bathroom) •Unusual Gait •Balance Issues •Chapped Hands or Lips/Mouth •Trichotillomania (Hair Pulling/Skin Picking) •Enuresis |
EXECUTIVE FUNCTION Symptoms
•Difficulty with Working Memory and Holding Information •Poor Organizational Skills •Time Management Issues •Difficulty Planning/Prioritizing Attention on a Single Task •Difficulty Making Decisions |
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Basic School Supports
Student needs and performance may vary widely from week to week.
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Communication Supports
Students benefit from strong and proactive school communication. Creating a IHCP - Individual Health Care Plan can help ensure these supports are in place and enforced. (Read More for Sample IHCP)
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Supports & Accommodations for different symptoms
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OCD
•Compulsions: ~Alter Work Sequence/ Alternative Schedule if stuck on section or task ~ID & Substitute less disruptive behaviors ~Timer to signal transitions ~If child is continually erasing work, allow computer ~Safe Space to release compulsion during day •Obsessions: ~Allow “interrupter” when in rut ie snapping band on wrist ~ID special words/prompts for teacher to interrupt obsessions ~Goal for curbing repetitive questioning •Group Activities: Allow separate set of materials •Allow early class dismissal to avoid crowds in hallways •Allow spell check/calculator to be used one time at end in case of anxiety/perfectionism |
Anxiety
•Relaxation Techniques •Safe Space – Safe Person •Cool Down Pass •Class Participation: fears range from inaccuracy to being looked at by peers-consider starting with close-ended questions or opinion questions. Signal child that it is almost their turn. Exempt participation as needed. •Class Presentations: Reports can be given to teacher alone or videotaped at home. •Testing: Extended time. Alternate testing location if anxiety increases by watching other kids turn in work quickly |
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Mood Changes
•Calming Techniques •Safe Space – Safe Person: ID 1 person to check in with for 5-10 minutes to ease mood changes to enable the return to class. •Cool Down Pass to allow child to leave situation briefly. Use a card to signal teacher so child does not become center of attention |
Sensory
•Sensory Supports: pressure, weighted vests, proprioception •Sensory Seeking: varying tactile input •Sensory Defense: low light, quiet space •Allowing hats to be worn in class if needed to apply pressure to head or shield from lighting |
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ADHD
•Extended Time •Frequent Breaks •Exercise Breaks •Redirection •Written Directions •Preferential Seating: close to teacher, away from window/door •Fidget Toys •Testing: Extra/Unlimited Time, Separate testing location if needed •Lighter homework load • Alarm Reminders to keep student on task |
Organization
•Assignment Planner: Weekly layout, keep pen with it, clip current week •Homework Binder with log for parents to communicate with teacher •Graphic Organizer & Outlining Programs •Long Term School Projects: Break down into segments with separate goal dates (topic selection, research, outline, first draft, final draft) •Color Code Subjects •Extra Set of Books for home use •Buddy to help take notes •Schedule time to clean desk/locker |
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Memory
•Management: Lists, Timers, Calendars •Repetition of Information •Review Time •Recording devices •Provide lecture notes/outline |
Dysgraphia
•Keyboard/Assistive Technology •Built-Up pencils •Graph paper/raised line paper •Grade work on content rather than neatness |
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Math Regression
•Math Facts, Formula Sheets, Calculator •Extended Time •Shortened Assignments •Manipulatives |
Language Issues
•Extra Time •Assisted Technology •Speech Therapy |
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Fatigue
•Time to rest. •Healthful snack |
Mobility Issues
•Adaptive PE •Physical Therapy •Field Trip accommodations/support |
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Urinary Frequency
•Low Key Bathroom Access •Tracking |
Lateness
•Late slip on file •Temporary later start time |
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Tics
•Nurse Breaks •Reading/Writing: Assistive Technology and allow oral Responses •Vocal Tics: Less reading aloud. •Testing Modifications |
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Additional Resources
General Resources
Little known disorder underscores education needs
By Patricia Rice Doran (Baltimore Sun-2014)
Read More
Families’ Experiences with PANDAS and Related Disorders
by Patricia Rice Doran of Towson University presented at the Council for Exceptional Children 2015 annual convention.
Read More
Considerations Regarding Academic Accommodations/Compensatory Strategies, and Services for Students with PANDAS/PANS
Jamie Candelaria Greene PhD, BCET
Read More at PandasNetwork
Pediatric Autoimmune Neuropsychiatric Disorders: A New Frontier for Occupational Therapy Intervention
Trudy Posner & Janice Tona
Read More
PANDAS School Daze Series: Back to School Lessons
Read More at PANDAS Sucks Blog
Letters to School
Letter Requesting Notification of Strep Exposure from Classmates
Read More at PandasNetwork
Letter to School while in PANDAS Exacerbation
Read More at PandasNetwork
Letter to School while in Remission
Read More at PandasNetwork
Little known disorder underscores education needs
By Patricia Rice Doran (Baltimore Sun-2014)
Read More
Families’ Experiences with PANDAS and Related Disorders
by Patricia Rice Doran of Towson University presented at the Council for Exceptional Children 2015 annual convention.
Read More
Considerations Regarding Academic Accommodations/Compensatory Strategies, and Services for Students with PANDAS/PANS
Jamie Candelaria Greene PhD, BCET
Read More at PandasNetwork
Pediatric Autoimmune Neuropsychiatric Disorders: A New Frontier for Occupational Therapy Intervention
Trudy Posner & Janice Tona
Read More
PANDAS School Daze Series: Back to School Lessons
Read More at PANDAS Sucks Blog
Letters to School
Letter Requesting Notification of Strep Exposure from Classmates
Read More at PandasNetwork
Letter to School while in PANDAS Exacerbation
Read More at PandasNetwork
Letter to School while in Remission
Read More at PandasNetwork
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